新生儿败血症PPT课件.ppt

Neonatology:NeonatalSepticemia,1,Lecturepoints,MorbidityandmortalityThecompromisedhostoftheneonatesinimmunologyPathogensforclinicalconsiderationClinicalmanifestationClinicalManagement,2,Incidence,1%10%,inlivebirth15-20%,inVLBW,3,Incidence,Grossincidence,Comparison:USanddevelopingcountries,4,NeonatalSepticemia,Deathrate:US,5,NeonatalSepticemia,Deathrate：developingcountries,LONS7.5%,deathrate:9.8%12%,6,ImmaturedevelopmentinbodydefenseImperfectfunctionLessexperienceofexposuretoenvironmentandpathogensAffectedbymaternalantibodies,Immunologicalfeaturesinneonates,7,Non-specificImmune:PoorbarriersfunctionUndevelopedcomplementactivationcapacityRelativefewerneutrophil,ImmatureFunctionLowerILs,lowerlevelofcytokines,ImmunologicalfeaturesinNeonates,8,SpecificImmune:QuantitiesandqualityofIgG,A,MT,Bcell:quantities,qualityandtheirfunction,ImmunologicalfeaturesinNeonates,9,Pathogens,Domestic:Staphylococcus:mostcommonlyseenEscherichiacoli,etc.G-bacillusUS:GBS:theleadingpathogenduring1970sEscherichiacoli:theleadingpathogenduring1990s,10,PathogenicChanges,EONS:ChangesbyG+vs.G-,Early1990s,Late1990s,11,PathogenicChanges,12,Relevantfactorsofpathogenicchanges,ChangeofcolonizedpathogensinmaternalbirthcanalGBSScreeningPreventiveantibiotictherapyusedduringprepartum,AmpicillineforthemotherwithGBSpositive:prepartumandIntro-partumGBSSepticemiaEfficacy：around70%（vs.controlP0.0001）,13,Pathogensbasedonthetypesindevelopedcountry,EONS：E.coliListeriamonocytogenes,PseudomonasMeningococcusEnterococcusandGBS,LONS：Coagulase-negativeStaphylococcusHaemophilusinfluenzabacillusOtherpathogens,14,Pathogensbasedonthetypesindevelopedcountry,15,LONS(48hoursafterbirth)Mainly:G+Coagulase-negativeStaphylococcusPartlyreported：Staphylococcusepidermidis,GBSandE.coli,EONS(within24-48hoursafterbirth)G+=G-G+：mainlyKlebsiellapneumoniaeandE.coliG-：Enterococcuscommonlyseen,VEONS(within24hoursafterbirth)Klebsiella、E.coli、Enterococcus,Pathogensbasedonthetypesindevelopingcountry,16,EarlyonsetdominantRelatedwiththematernalandtheintro-partumhighriskfactors,Pathogensbasedonthetypesindevelopingcountry,17,PathogensisolatedinChina,mainisolatesfrombloodculturebsedontheages:n=671/458/1849,临床儿科杂志：2002-2浙江大学附属儿童医院资料,18,PathogensisolatedinChina,中华儿科杂志01-6；重庆儿科医院资料,Domesticdata：mainisolates:n=815,19,mainisolatesaccountforduringdifferentperiods:n=436,临床儿科杂志02-5：深圳市人民医院儿科资料,PathogensisolatedinChina,20,PathogensisolatedinChina,临床儿科杂志02-5：深圳市人民医院儿科资料,mainisolatesaccountforduringdifferentperiods:n=436,21,PathogensisolatedinChina,mainisolatesaccountforduringdifferentperiods:n=606/475,临床儿科杂志：2002-2哈尔滨儿童医院资料,22,ThepathofInfection,Path:IntrauterineinfectionIntro-partuminfectionPostdeliveringinfection,23,Maternalintro-partumfever(OR=4.1CI=1.2-13.4)RepeatedVaginalexaminations(OR=2.9CI=1.1-8.0)AmongGBSSepsis,Dystociaandmaternalfeveraccountfor49%Prolongedmembranerupture18hour（79%）PrematuresandLBWLateronsetsepsis:PDA,LongtimeofIntravascularcatheter,variousofinvasiveprocedure,BPD,Riskfactorsofsepsisoccurrence,24,Clinicalmanifestations,General：AnorexiaLessCryingFewerphysicalactivitiesLowertemperatureorfeverPoorweightinggainPersistentJaundice,Focal:OmphalitisSkininfectionBlepharitis(eyes)OtitismediaParonychia(nails),25,Clinicalmanifestations,Toxic:ShockHepatosplenomegalySkindepositionpointDistensionAnemia,Complication:MeningitisPneumoniaPeritonitisUrinaryTractInfectionScleredemaDICToxicmyocarditis,26,Laboratoriesandinvestigationaids,PeripheralwholebloodtestBloodcultureOthers:CRP/PCTSmearofWBC:checkbacterialCSFUrineCXR,27,ClinicalManagement,AntibiotictherapySelectionbasedonthepathogenisolatedEarly,Adequatedose,IVDuration:2weeksforG+,3weeksforG-.Longerdurationformeningitisandsevere,28,SupportivetherapyDehydrationCorrectmetabolicacidosisMaintenanceofelectrolyteandAcid-basebalanceEnoughenergysupplyKeepwarmCorrecthypoxemiaImmunologica